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Probiotic mitigates gut hypoperfusion-associated acute gastrointestinal injury in patients undergoing cardiopulmonary
Xiaofang Yang1,2, Ruisheng Liu1,2, Zhijing An2
1The First School of Clinical Medicine, Lanzhou University, Lanzhou, 730030, Gansu, China.
Insights
Preoperative probiotic supplementation significantly reduced acute gastrointestinal injury (AGI) in patients undergoing cardiopulmonary bypass (CPB). This intervention also lowered ICU stay and nosocomial infections, suggesting a protective role for probiotics.
Area of Science:
- Gastroenterology
- Cardiology
- Microbiology
Background:
- Acute gastrointestinal injury (AGI) following cardiopulmonary bypass (CPB) is linked to poor patient outcomes.
- Evaluating preoperative probiotic supplementation's impact on AGI incidence in CPB patients is crucial.
Purpose of the Study:
- To assess the efficacy of preoperative probiotic supplementation in preventing AGI in patients undergoing CPB.
- To identify risk factors for AGI and the protective role of probiotics.
Main Methods:
- A double-blind, randomized controlled trial involving 52 patients undergoing CPB.
- Patients received daily probiotics or placebo for seven days pre-surgery.
- AGI incidence, ICU stay, nosocomial infections, and gut microbiota were analyzed.
Main Results:
- AGI incidence was significantly lower in the probiotic group (15.38%) versus placebo (42.31%), P=0.032.
- The probiotic group experienced shorter ICU stays (P=0.041) and fewer nosocomial infections (P=0.048).
- Probiotic supplementation was identified as the sole protective factor against AGI in multivariate analysis.
Conclusions:
- Preoperative probiotic supplementation is a potential strategy to decrease AGI and related complications in CPB patients.
- Probiotics may serve as a preventive intervention for AGI in this vulnerable population.
- Significant alterations in gut microbiota composition were observed with probiotic use.
Background:
Acute gastrointestinal injury (AGI) after cardiopulmonary bypass (CPB) is associated with poor prognosis. This study aimed to evaluate the effect of preoperative probiotic supplementation on the incidence of AGI in patients undergoing CPB procedure.
Methods:
This was a double-blind, randomized controlled trial conducted in a single center. The patients undergoing HVR with CPB between September 2022 and February 2023 were randomly assigned to receive either probiotic (Lac group) or placebo (Placebo group). The probiotic was administered daily for seven days prior to surgery.Univariate and multivariate logistic regression analysis was performed to identify independent risk factors for AGI. A P-value < 0.05 was considered statistically significant. Gut microbiota composition was assessed using 16 s rRNA analysis.
Results:
A total of 52 patients were randomly assigned to two groups (26 in the Lac group, 26 in the Placebo group). Patients were followed for at least 30 days after surgery. During the follow-up period, 15 of the 52 patients (28.85%) developed AGI. The incidence of AGI was significantly lower in the Lac group (15.38%) compared to the Placebo group (42.31%), with a difference of 26.93% (P = 0.032). Moreover, patients in the Lac group had a significantly shorter ICU stay (6 [5, 36] vs. 5 [4, 5.5] days, P = 0.041) and a lower incidence of nosocomial infections (11.54% vs. 34.62%, P = 0.048). Multivariate analysis identified a higher Cardiac Surgery Score (CASUS) and CPB duration ≥ 132 min as independent risk factors for AGI, whereas probiotic supplementation was the only protective factor. Furthermore, 16S rRNA sequencing revealed significant differences in gut microbiota composition between the Lac and Placebo groups.
Conclusions:
Preoperative probiotic supplementation may be an effective strategy to reduce the incidence of AGI and AGI-related complications in CPB patients. These findings suggest that probiotics could be considered a preventive intervention for AGI in this patient population.
Trial Registration:
ClinicalTrials.gov: NCT05498948.
